I am seeking a Companion

Full Name*

Phone Number*

Email Address*

City / Neighborhood*

Best way to contact you*

Name of loved one*

Age*

Current living situation*

Briefly tell us about their personality, routines, and care needs:*

Please select all that apply:
Companionship and social engagementAssistance with daily routinesPersonal careMeal preparationLight housekeepingTransportation and errandsMedication remindersMobility supportOvernight supportWeekend supportLive-in careLive-out care

Desired start date*

Days and hours needed*

Daytime, overnight, weekend, or flexible support*
DaytimeOvernightWeekendFlexible support

Live-in or live-out*
Live-inLive-out

What qualities are most important to you in a Companion?*

Do you prefer someone with experience in Alzheimer’s or dementia care?*
YesNoNo preference

Are there pets in the home?*
YesNo

Is driving required? Family Car or Companion's Car?*
No driving requiredYes, using Family CarYes, using Companion's Car

Rate range you are offering*

Will you provide paid sick time according to California law?*
YesNo

Will you offer paid vacation or holidays?*
YesNoOpen to discussion

Is there anything else you would like us to know?

What would make this match feel successful for your family?*

*Rainbow Companions operates under the umbrella of Rainbow Nannies.

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